The Different Types of Arthritis and Treatment
By Jillian Foglesong Stabile, MD
Arthritis is defined as inflammation in the joints and usually presents with pain in the affected joints. Many conditions can cause arthritis. Arthritis can target one joint or can be more widespread throughout the body. Each type of arthritis presents differently and has different treatment options.
Osteoarthritis
Osteoarthritis is also known as wear and tear arthritis. It is a disease that affects the entire joint and causes loss of cartilage as well as changes in the bones. It is the most common type of arthritis. This type of arthritis can affect any joint and is more common as you age.
Causes of osteoarthritis
The incidence of osteoarthritis increases with age and usually appears after age 50. Previous injury to a joint increases the risk of arthritis in that joint as does pre-existing abnormalities in joints or muscles. If you work a job that is high impact or if you participate in sports, overuse of a joint can increase your risk. Osteoarthritis is also more likely if you have a family history of the disease or if you are a woman. Muscle weakness can also lead to poor alignment of the joints and ultimately osteoarthritis. Obesity increases the stress on the joints and fat cells promote inflammation which significantly increases the risk of osteoarthritis.
Diagnosing osteoarthritis
Osteoarthritis can be diagnosed based on history and physical exam. Morning joint stiffness lasting 30 minutes or less, pain in the joints, and swelling are all symptoms of osteoarthritis. Laboratory testing is not usually helpful in making the diagnosis but can help rule out other conditions. X-rays will show narrowing of the joint spaces and potentially extra bony growths called osteophytes. X-rays can help determine how severe the arthritis is and can help guide treatment.
Treatment of osteoarthritis
Treatment of osteoarthritis falls into several categories: lifestyle, medication, and surgical. Complementary and alternative medicine may also play a role.
Lifestyle modification
Lifestyle modifications include losing weight, physical therapy, strength training, water-based exercise, stretching and flexibility exercises, and possibly mobility aids such as a walking stick, walker, or in some cases a brace for the affected joint. Studies have shown that the single most important modifiable risk factor is obesity, so weight loss is one of the most important things that you can do to decrease your risk of osteoporosis as well as improve your pain.
Medications
Medication treatment for osteoporosis includes over-the-counter and prescription medications. Joint injections performed by a healthcare provider are also sometimes recommended.
Non-steroidal anti-inflammatory medications (NSAIDs) are one of the first-line classes of medications used for osteoarthritis. These medications come in topical and oral forms. Topical medications decrease the risk of stomach inflammation associated with oral NSAIDs. The biggest side effects associated with NSAIDs are related to their effects on the stomach.
Capsaicin can also be used topically. This is a compound derived from hot peppers. Studies have shown that they can reduce pain in knee osteoarthritis by up to 50%.
Acetaminophen is an oral medication that treats mild to moderate pain. It doesn’t have the same risk of stomach upset as the NSAIDs do. They are metabolized in the liver, so patients who consume excessive alcohol or have underlying liver disease may need to use caution with these medications.
Opioid pain medications are used when patients can’t tolerate or can’t take NSAIDs. These medications are highly controlled because of their addictive risk. There is an increased risk of adverse events related to the withdrawal of these medications. Benefits are limited in the long term.
Duloxetine is an antidepressant medication that also indicates chronic pain. It may also help with nerve-related pain from this condition. This medication is frequently used in combination with NSAIDs or acetaminophen.
Intra-articular joint injections are performed by your healthcare provider. The injection may consist of steroids and numbing medication or hyaluronic acid. Steroids decrease inflammation. Hyaluronic acid may help lubricate the joint.
Surgery
Joint replacement surgeries are not possible for every joint, but it is an option for some patients who don’t respond to conservative treatment.
Inflammatory arthritis
Inflammatory arthritis is a group of autoimmune diseases. Your body attacks your joints causing inflammation and destruction of the cartilage. Rheumatoid arthritis, lupus arthritis, ankylosing spondylitis, and psoriatic arthritis are all types of inflammatory arthritis.
Causes of inflammatory arthritis
Inflammatory arthritis is more common in women than in men. Inflammatory arthritis can be triggered by some types of cancer in addition to autoimmune diseases. Generally, something triggers the body to attack itself leading to inflammation and pain.
Diagnosing inflammatory arthritis
As with most types of arthritis, inflammatory arthritis evaluation starts with a history and physical exam. Joint pain may be worse in the mornings and persist for 45 minutes or longer. Typically the joints are inflamed. Laboratory studies may show evidence of inflammation with an elevated erythrocyte sedimentation rate or C-reactive protein. In some cases, there may be excess platelets or anemia present. A series of immune markers may indicate which type of inflammatory arthritis is present. X-rays are sometimes used to look for bony erosions in the joints. If joint effusions are present, draining the fluid and evaluating it under a microscope can help point to the cause.
Treatment of inflammatory arthritis
The treatment of inflammatory arthritis generally depends on what type of inflammatory arthritis is present. NSAIDs are frequently used to treat pain. Steroid medications may be used to treat inflammation but can increase the risk of diabetes and osteoporosis. Disease-modifying drugs (DMARDs) are medications designed to treat the underlying cause of the symptoms. These medications suppress the immune system. There are many options with a wide variety of benefits and side effects associated with these medications.
Reactive arthritis
Reactive arthritis is more common in young men. It is frequently associated with chlamydia infection but can be caused by other infections as well. This type of arthritis causes pain in multiple joints.
Causes of reactive arthritis
Reactive arthritis is triggered by multiple different organisms but the most common is Chlamydia trachomatis which is a common sexually transmitted infection. Some types of food poisoning can also cause reactive arthritis. Most patients who develop reactive arthritis have a genetic susceptibility called HLA-B27. Interestingly, HLA-B27 is associated with inflammatory arthritis as well, specifically ankylosing spondylitis.
Diagnosing reactive arthritis
Reactive arthritis causes joint stiffness and pain. The joints become red and swollen. The fingers or heel may swell as well. Infections of the reproductive or urinary tract can occur. Eye inflammation is also sometimes seen. The diagnosis is usually made based on history and physical exam, but testing for underlying infection is also helpful. Chlamydia can be detected in the urine. Sometimes stool studies or blood tests are used to rule out food poisoning or HIV.
Treatment of reactive arthritis
Treatment of reactive arthritis involves treatment of the underlying infection. The rest of the symptoms associated with reactive arthritis generally improve with time.
Infectious arthritis
Infectious arthritis is also known as septic arthritis. It can affect children and adults. Septic arthritis usually starts in 1 joint but can spread to other symptoms and cause systemic symptoms.
Causes of infectious arthritis
Infectious arthritis can be caused by several organisms. Most commonly, the infections are bacterial. The type of bacteria that is likely to cause infectious arthritis depends on the age and other conditions that a patient may have. For example, gonorrhea arthritis is more common in sexually active adolescents, while group B streptococcus is more common in newborns. Staphylococcus aureus is the most common bacteria that affects adults.
Diagnosing infectious arthritis
The presentation of infectious arthritis may present differently depending on the type of organism causing the infection. History and physical exam are important in making the diagnosis. The history may indicate the source of the infection. Lab work includes blood counts to look for infection and inflammatory markers to look for inflammation. If fluid is present in the joint, then getting a sample of the fluid for culture and other testing will help identify the organism.
Treatment of infectious arthritis
Treatment of infectious arthritis usually requires intravenous antibiotic therapy. If the infection is in a joint that has been replaced, then sometimes removal of the infected hardware is necessary. Prompt treatment is necessary, which often means treating the infection before the exact cause is identified. Treatment is based on which organisms are suspected after careful consideration of the history and physical exam.
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Dr. Foglesong Stabile is a board-certified Family Physician who enjoys full scope Family Medicine including obstetrics, women’s health, and endoscopy, as well as caring for children and adults of all ages. She also teaches the family medicine clerkship for Pacific Northwest University of Health Sciences.
References:
https://www.arthritis.org/diseases/osteoarthritis
https://www.aafp.org/pubs/afp/issues/2012/0101/p49.html
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4653978/
https://www.americaspharmacy.com/drug/capsaicin/
https://www.americaspharmacy.com/drug/acetaminophen/
https://www.americaspharmacy.com/drug/duloxetine/
https://arthritis.ca/about-arthritis/arthritis-types-(a-z)/types/inflammatory-arthritis
https://www.ncbi.nlm.nih.gov/books/NBK507704/
https://www.aafp.org/pubs/afp/issues/1999/0801/p499.html
https://www.niams.nih.gov/health-topics/reactive-arthritis